Please supply details of at least two professional references. References should be from previous employers. One reference from the candidates most recent employer and a previous employer where applicable i.e. within last 2 years. Most recent reference must be from a department head or above. All references must be sent to the referees place of work, please supply this information.

Reference - 1

Name:

Position:

Address:

Telephone:

Fax:

Email:

Reference - 2

Name:

Position:

Address:

Telephone:

Fax:

Email:

Reference - 3

Name:

Position:

Address:

Telephone:

Fax:

Email:

Section 7 - Work Requirements

I provide my permission for JustNurses to approach the professional referees that I have listed above and/or included on my CV in order to obtain professional references for the purpose of registration and clearance for locum work with the NHS.

What kind of work are you looking for?

Available to start work from?

Do you hold a current full UK driving licence?

Do you have regular use of a vehicle?

Section 8 - Professional Conduct

Have you ever been the subject of professional misconduct proceedings or disciplinary proceedings or disciplinary action from an employer, or are such pending or threatened against you either in the uk or abroad?

If yes, please give details:

Section 9 - Rehabilitation of Offenders Act

The Rehabilitation of Offenders (Amendment) NI Order 2012 permits persons in certain circumstances to ignore offences committed in the past when asked to give details of previous convictions. These convictions are known as “spent convictions”. However the Rehabilitation of Offenders (Exceptions) (Amendment) Order (Northern Ireland) 2012 states that those employed in the medical/care fields are not allowed to withhold details of any offences for which they have been convicted, however long ago these convictions may have been served.

Do you have any convictions or cautions:

Please detail below all convictions and cautions regardless of the seriousness of the offence and how long ago the conviction occurred:

This information may be shared confidentially and at an appropriate level with prospective employers to enable them to make a recruitment decision.

Section 10 - Access Northern Ireland

All recruitment agencies and NHS bodies are required by law to ask all applicants to apply for an Enhanced Access NI Disclosure, as the job for which you are applying may involve access to children and vulnerable adults. It is therefore exempt from The Rehabilitation of Offenders (Exceptions) (Amendment) Order (Northern Ireland) 2012.

In order to secure work for you, we require an Enhanced Access NI is undertaken. We as an organisation need to apply for an Enhanced Access NI Disclosure for you in our own company name. Full details regarding this process will be provided to you by your Recruitment Consultant.

Section 11 - Emergency Contact Details

Please give details of the person you would like to be contacted in the event of an emergency.

Name:

Relationship:

Address:

Telephone:

Email:

Section 12 - Bank Details

Please provide your bank details below.

Bank Name:

Sort Code:

Account Name:

Account Number:

Address:

Section 13 - Working Hours

In compliance with the implementation of the working time regulations, JustNurses Limited recommend that working time should not exceed 48 hours per week (averaged over a period of 17 weeks). However, should you wish to waive this right, please indicate this preference by ticking below:

Do you wish to waive this right?

You can change your chosen option at any time by giving appropriate notice in writing to JustNurses. Working time shall include only the period of attendance at each individual assignment through JustNurses. It shall not include travelling time unless specifically agreed by the JustNurses Manager.

We take data privacy and security very seriously and your personal information will be processed and secured in accordance with The General Data Protection Regulations (GDPR). Our privacy policy can be viewed on our website.

Temporary work dictates the need for quick, effective communication for us to secure assignments for you. It is therefore essential for us to maintain regular contact with you across multiple channels. This includes; phone, Email, SMS and in-app push notifications (where applicable). Your consent is required for us to do so.

Section 15 - Uploads

Please use the upload section below to attach all the scanned documentation required to complete your registration process.

This could include: CV, original passport, passport photos, proofs of address, proof of professional registration, driving licence, birth certificate, proof of immigration status, proof of porfessional indemnity, national insurance card or inland revenue doucments, certificates for all qualifications etc.

Please be aware if your attachments exceed 14mb (in total) this may result in the failure of your submission, if this should happen please go back one step and reduce the number attachments/file sizes accordingly.

Section 16 - Declaration

As required by the data protection act; all personal data provided to JustNurses will be treated as confidential and stored / managed on our secure servers.

I consent that JustNurses can transmit my information to third parties for the purpose of finding suitable employment and obtaining essential supporting documentation. This consent covers any information necessary whilst representing me; including but not limited to my application, training & compliance, work placements, payroll and general day-to-day correspondence.

I understand that any personal data held by JustNurses Limited is liable to be inspected by NHS Crown Commercial Service (CCS) and other third party organisations as part of audit procedures and provide my permission for JustNurses Limited to disclose all or any element of my personal data for this purpose.